Temporal distribution of recorded indications for first revision total knee arthroplasty: a multicentre Chilean cohort of 150 patients
In brief
Infection causes one-third of early revisions; loosening causes half of late revisions
In a Chilean series of 150 first-revision knee arthroplasties, 34% of revisions performed before 24 months were due to infection, whereas 54% of those after two years were for aseptic loosening. The pattern persisted after adjusting for age and sex, highlighting different surveillance priorities over time, though selection bias limits causal inference.
- Journal
- Journal of ISAKOS : joint disorders & orthopaedic sports medicine (Q1)
- Published
- 23 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Jorge Isla Villanueva, Waldo Gonzalez Duque, Matías Hebel Lorca, Pablo Escudero Acurio, Eduardo Poblete Durruty, Vicente Alba Maldonado, et al.
- PMID
- 42777824
- DOI
- 10.1016/j.jisako.2026.101223
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 27 September 2026): Orthopedic revision study, no radiation physics relevance
Abstract
INTRODUCTION: /Objectives: Recorded indications for first revision total knee arthroplasty (TKA) may vary with time after the primary procedure. This study compared their distribution among early and late first revisions in a multicentre Chilean cohort. METHODS: This retrospective non-consecutive cohort included 150 unique patients who underwent first revision TKA at five Chilean centres between 2018 and 2026. Revisions were classified as early (<24 months) or late (≥24 months). Indication distributions were compared using categorical tests, including a fixed-margin Monte Carlo procedure for sparse cells. Logistic regression adjusted for age and sex. Sensitivity analyses incorporated revision year and centre and modelled time continuously, including assessment of non-linearity. RESULTS: Mean age was 70.1±9.5 years, and 97 patients (64.7%) were women. Fifty-three revisions (35.3%) were early and 97 (64.7%) were late. The indication distribution differed by timing (Monte Carlo p=0.0003; Cramér's V=0.41). Infection was the most frequent early indication (18/53, 34.0%), whereas aseptic loosening accounted for more than half of late revisions (52/97, 53.6%). After adjustment for age and sex, late revision was associated with higher odds that aseptic loosening was the recorded indication (adjusted odds ratio [OR], 6.70; 95% confidence interval [CI], 2.80-16.00; p<0.001). Early revision was associated with higher odds that infection was the recorded indication (adjusted OR, 3.21; 95% CI, 1.40-7.34; p=0.006). Estimates were similar after accounting for revision year and centre and when time was analysed continuously. CONCLUSION: Among the included first revisions, infection was the most frequent recorded indication before 24 months, whereas aseptic loosening was the most frequent indication thereafter. These within-cohort associations remain subject to selection bias, diagnostic misclassification and residual confounding, and do not estimate cause-specific revision risk after primary TKA. LEVEL OF EVIDENCE: III.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.